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Programme Highlights “BRAC taught me about many issues including proper nutrition, safe pregnancy and clean water. When people are sick, I refer them to the hospital. In one month I can make around LRD 1,000 (USD 14) profit. They come to my house, even at four in the morning. I feel good that I can save lives.”
Esther G. Daniels, Community Health Promoter, Paynesville South Branch
The war greatly weakened Liberia health care system, partially or completely destroying about 95% of the country’s 325 health facilities. There are fewer than 100 physicians to serve the Liberian population of almost 3.5 million and life expectancy at birth is among the lowest in West Africa. The health status of most Liberians is generally poor and access to formal health facilities is often impossible for many. To address the issue of access to health services, BRAC began community health activities in Liberia in 2008, following a proven model of community health care developed in Bangladesh. The health programme takes a multi-pronged approach to reduce the health risks for poor communities in Liberia. We focus on the prevention and control of malaria, tuberculosis (TB) and HIV/AIDS, the reduction of infant and under-five mortality rates and increasing accessibility to health by taking health care to the doorstep of the people.
Diagnostic Laboratory
BRAC identifies and trains women from our microfinance groups to become Community Health Promoters (CHPs) and employs female Programme Assistants (PA) to supervise them. The women we select for the CHP training have been recommended by their microfinance officers and have a business that gives them time to conduct daily household visits. They are the central point of contact for health concerns in their communities. In 2010, we trained 550 Liberians as CHPs to provide basic health care door to door. Each CHP has the overall responsibility for 150-200 households in her area that she will visit every month – all within one kilometre of her home. CHPs earn a small income from selling health care products such as condoms, oral rehydration solution, sanitary napkins, hygienic soap, water purification tablets and some over-the-counter drugs, such as paracetamol, anti-histamine and antacid.
BRAC recruited two local staff as lab aids who were given one month hands on training in laboratory testing techniques. Additionally, CHPs and Programme Assistants were given a 5-day training course on Rapid Diagnostic Test for influenza, sputum collection and proper processing, preservation, and transport of lab samples. The lab puts particular focus on tuberculosis and malaria diagnoses.
BRAC health staff Angeline G. Blama describes her experience with her community: “I went with a CHP to talk about TB to a group. After hearing of the symtoms of TB, one woman said that a relative in another community who was ill may have contracted TB. She had been to the hospital, but they diagnosed her with a cold without testing for TB and gave her the treatment for cold. I instructed her to return to the hospital and get tested for TB. Later, I followed up and found out she had indeed been diagnosed with TB and was improving after undergoing treatment at the hospital. The community now knows that TB can be cured, they can talk about it in the open.”
In October 2010, BRAC opened a diagnostic laboratory to help meet the demand for affordable medical laboratory facilities. The lab provides affordable diagnostic services, focusing on marginalised and vulnerable groups. It is also helping reduce transmission of infections and supporting appropriate treatment of diseases through early case detection. On arrival, all patients are registered and, following an initial consultation, provided recommendations on appropriate lab diagnostics. They are then offered medical advice and treatment by the medical practitioner on staff. An adjacent drug dispensary sells prescription drugs at affordable prices. While basic diagnostic services are provided to most for an affordable service charge, subsidies are given to those who are unable to afford the basic fees.
ACHIEVEMENTS 2010 106,938 household visited by 550 CHPs 58,014 patients treated with basic palliative care, and 15,431 patients referred to the nearest health facility for follow up treatment and testing 140,910 participants attended 16,498 community health forums organised by BRAC health staff 330 consultations and 544 lab tests performed at the diagnostic laboratory since its launch